Choosing Wisely Campaign Celebrating 5 Years

Newtown, CT - October 27, 2017

Moving medical education from thoroughness to appropriateness is a close to incredible accomplishment. The next phase is to move it to affordability – Neel Shah and his colleagues at Costs of Care, in collaboration with our good friend Daniel Wolfson and the ABIM Foundation, leveraged the Choosing Wisely campaign to launch an ambitious program to instill in the next generation of physicians a greater sense of the responsibility to be good stewards of health care resources while being the stewards of their patients’ health. In a recent Health Affairs blog post that was timed with the 5th anniversary of Choosing Wisely, the Costs of Care crusaders explain the road they have traveled and the road ahead. While the rest of the industry is standing around harrumphing Choosing Wisely, they should instead pay attention to the significant and hopeful accomplishments that are taking place in the country’s elite medical schools. And they should also pay attention to what will happen next in the movement to highlight low value care, because that will be the true legacy of what Daniel launched five years ago.

What this means to you – Choosing Wisely was never designed to be the mother of all cost saving strategies, let alone a step child. Instead it was designed to change the culture of medicine from one in which everything that is done by a physician for a patient is always good, to one in which there is an overt admission that not everything is appropriate. And that mission has succeeded far better than any of us really thought it would. While only about a quarter of physicians are aware of the campaign, I would submit that it’s astonishing that so many are. Getting to 100% is not the ABIM Foundation’s job but that of the medical specialty societies that have provided the recommendations to the campaign, because it is at that level that accountability for the continued overuse of low value services rests. What is also astonishing is that the campaign has enshrined in American medicine the concept of low value care. No one denies that it exists, that it continues to be highly prevalent, and that it has to be reduced. That’s something that we and others have built on because the overused services identified in the Choosing Wisely campaign are only a fraction of the total low value care that is being produced by American medicine. Some estimates are as high as 30%, and our work supports that range. Cutting low value care by half would massively increase affordability of health care at a critical point in this nation. Of course, that won’t happen overnight, nor even in the next year, but no one disputes that it must be done. In late 1999, and then in early 2000, with the one-two punch that was the IOM’s “To Err Is Human” and the creation of the Leapfrog Group, the national discourse on the essential importance of public reporting of quality of care changed. Improving patient safety became the norm even if much work is yet to be done to make health care truly safe for patients. Choosing Wisely has done the same for affordability. While price increases have stalled across the nation, health plan premiums, in particular for average and below average income families, are increasingly unaffordable. And that won’t change unless we root out all aspects of low value care. Young doctors are getting the message, but that’s not enough. So the crusade broadens and the battles will be fought on every front to hold accountable those who are burdening patients and consumers with low value care, because that’s what will get us to affordability. And to Daniel and the Choosing Wisely campaign, happy birthday and thanks for all you’ve done.

François de Brantes

François de Brantes is Vice President and Director, Center for Payment Innovation (CPI), which designs and implements innovative payment and benefit plan design programs to motivate physicians, hospitals, and consumer-patients to improve the quality and affordability of care. CPI works with states, employers, health plans, and provider organizations, as well as national consultancies such as McKinsey and KPMG, to advise them on payment and delivery system reform.

Mr. de Brantes has been published in peer-reviewed journals such as The New England Journal of Medicine, JAMA, and Health Affairs and is frequently quoted in national media, including The New York Times. He has also published two books, the latest being “The Incentive Cure: The Real Relief For Health Care.”